Episode Transcript
[00:00:01] Speaker A: Welcome to Align to lead. I'm Dr. Megan Parks, and today we're talking about real solutions for women's health, healing and balance.
You're watching now Media Television.
Welcome to Align to lead. I'm Dr. Megan Parks, and today we're opening with an important conversation about the brain, the body, the symptoms that too many people quietly try to push through.
Memory issues, mental fatigue, stress, slower processing, trouble focusing or feeling unlike themselves after an injury, illness or neurological change.
My guest is Dr. Nancy D. Kiravalatti, a leading researcher at Kessler foundation whose work focuses on cognitive rehabilitation, multiple sclerosis, traumatic brain injury, memory, processing speed, and daily life function. Dr. Nancy welcome to Align to Lead.
[00:00:54] Speaker B: Thank you. It's a pleasure to be here. Thank you for having me.
[00:00:57] Speaker A: Absolutely. It's a pleasure for us as well.
I am so curious, what first led you to the field of cognitive rehabilitation and neuroscience research?
[00:01:07] Speaker B: My interest in cognitive rehabilitation really stemmed from my interest in memory when I was in college.
My interest in the brain and memory stems all the way back to when I was a sibling, sophomore, junior in college, and I started reading a lot about the brain and memory functioning and different neurological illnesses. And one thing just led to another. I explored different career opportunities, different graduate training opportunities, decided to go into neuropsychology. And then once I was in neuropsychology in graduate school, there were just so many different directions to go through to go, to go in. But it was really memory that always triggered my interest the most and why our memory fails and how we can help our memory improve.
And all those questions that were
[00:01:59] Speaker A: around
[00:02:00] Speaker B: back then 25, 30 years ago, but they're still with us today, and we're still working on ways to solve the great memory problem.
I just found memory and the brain fascinating throughout my adult life.
[00:02:14] Speaker A: Oh. And especially as people are getting older and, you know, we see the Alzheimer's and dementia, memory has become a huge topic today.
[00:02:22] Speaker B: Absolutely.
[00:02:23] Speaker A: When, when people are experiencing cognitive issues such as changes from brain injuries, multiple sclerosis, or even other neurological illnesses, what are some early signs or even symptoms that family may dismiss or even minimize?
[00:02:40] Speaker B: So this is a tough question because I don't like people to overreact.
We're human. We are not computers. Our memories are not perfect. They're not designed to be perfect. Memory failures are common and completely normal. What I tell people is you want to start paying attention when memory failures are consistent. When you find yourself forgetting things or unable to follow along in conversations or confused often. If it happens on a daily basis, then it's something you might want to look into.
If it just happens here and there, we all forget where we put our keys. We all go into the kitchen and forget why we went there. We all forget names when we first meet people. That's totally normal. And a lot of that is really attention. And as well as the way in which we're learning new information.
It's not necessarily pathology.
I don't like people to overreact because we all really do get worried about our memories.
I really tell people to look for consistency in cognitive failures as opposed to this happened today. And does this mean that my memory is failing because. Because it's really consistency in failures that we're looking for?
[00:04:04] Speaker A: No. That's such a good point. And I kind of wanted to add a little bit more into that. Why do you feel symptoms like the memory difficulty, the mental fatigue, the slower processing speed. Why do you deserve it or why should it deserve more serious attention rather than. Unfortunately, sometimes we are putting it into this dismissed as normal aging or stress because we all have it. And of course, when we're stressed, we're not thinking clearly.
Like, why would you feel like that needs more attention? And how do they recognize that? I guess so.
[00:04:38] Speaker B: There are two reasons. I think we need to pay attention to it. The first is that there are things we can do to intervene. We can make memory better. We have techniques that we have tested at Kessler foundation, people have tested elsewhere that work. And there's evidence demonstrating that we can improve processing speed, we can improve memory functioning.
And I think it's important that people know that those things are out there. But the second reason is that the data is showing that when we intervene earlier, we get larger effects. So it's more effective when we treat people early, when they have minimal deficits, than when we wait and treat people later. And that has a lot to do with cognitive reserve and the healthy brain tissue that is still there.
But it's important to note that the earlier we intervene, the better effects we get.
[00:05:35] Speaker A: No, great, great thing again, always being on the front end rather than the end. It's so much easier to work on prevention rather than try to treat the whole thing all over again.
[00:05:45] Speaker B: Absolutely.
[00:05:46] Speaker A: When someone's never heard. So if someone's listening and they have never heard the term before, how do you explain cognitive rehabilitation to them?
[00:05:56] Speaker B: So cognitive rehabilitation is a set of tools in which we work with people to strengthen their cognition.
So it's not medication.
It's nothing invasive.
Basically, what we do is we work with an individual and we give them memory exercises or we do processing speed exercises and they are asked to do tasks over and over again in some cases.
In other cases, they may be asked to remember information differently. So where you may try to remember something by just reading a word and remembering it, one of the things we teach people to do is take that information and visualize it.
That's a different way to remember the information. It engages more areas of the brain and it has demonstrated efficacy in terms of helping people remember things better.
Those are the kinds of things we do in cognitive rehabilitation. One thing that's really important with cognitive rehabilitation is it's not a one time thing. You don't meet with someone for one session and all of a sudden your cognition's better. That's not the way it works.
Cognitive rehabilitation, the protocols we have are multi session protocols. They could last 10 sessions, they could last 20 sessions. We often tell people, if you continue to practice this after you're done, that's going to help you. It's not like you take a pill and all of a sudden your memory is better. That's just unfortunately not the way it works. It takes constant practice and learning more information.
[00:07:42] Speaker A: Good point. I joke around with people. We live in a fast food society. We want it, we want it now.
[00:07:47] Speaker B: Exactly.
[00:07:50] Speaker A: I'm going to actually add to that.
How can you help assist people and work through that? Because again, they're trying to deal with this and they are just thinking in their head, well, one session, I should be good. How do you help with those barriers?
[00:08:05] Speaker B: So one way to think about it is when we take a college course.
It's a course that you take over a period of four months. You're in class an hour and 15 minutes. At least two times a week, sometimes three times a week, you have homework. There's a lot of effort that goes into that. And that is simply one course in one topic.
Now what we're doing is we're trying to strengthen our memory functioning.
That's even bigger than one course. So why would it just take one session?
It doesn't make any sense. You really need to dedicate the time to that and the time that we dedicate to other things.
So we really need to just pay attention to it.
[00:08:50] Speaker A: No, you made a very good point. And the whole time I'm thinking, oh darn, she's telling us we still have to learn.
Well, and I think that's a really.
[00:08:58] Speaker B: You just made a really important point. We learn every single day. When we think about learning, we think about a college student or a high school student. But in reality, when we go through our days, we're constantly learning. We, we may be going to a store, through to a new store and you're learning where that store is and the layout of that store. You may need meet a new colleague at work. You may need to remember a website or a phone number. We're learning every single day, all day long. It's core to human existence to be learning. So it's really important that we protect our ability to learn.
[00:09:34] Speaker A: That's amazing. Well put for my women out there who are trying to reconnect with their bodies and regain that confidence.
Why is brain health such an important part of their healing conversation?
[00:09:47] Speaker B: The brain is our control center. It controls every aspect of who we are and everything we do. It controls our motor functioning, our cognitive functioning.
It's responsible for our mental health, our behavior.
That's all centralized in the brain.
So any alteration in brain function is going to impact the human globally. It's not going to have just one discrete symptom. It can have a very broad impact.
That's why we really need to pay attention to brain health.
When we lose confidence or we may have emotional challenges, depression, anxiety, it's really important to pay attention to those things and to try to address them. And because they do have, there is a domino effect where when someone is experiencing depression, very often they may start having memory difficulties or if they're anxious, they may start having cognitive issues, whether it be processing speed or memory, because those emotions, those feelings, the way the brain is operating, it impacts other functions. So it's very important to try to address these issues so that they don't cascade into much bigger issues again.
[00:11:09] Speaker A: Such a good point. And coming up next, we will look into cognitive rehabilitation and what it actually does, how the brain learns again and why recovery must, must connect clinical progress with everyday life.
We'll be right back with more practical tools to help you feel healthier, stronger and more aligned. Stay tuned. We'll be right back with more practical tools to help you feel healthier, stronger and more aligned. Stay tuned.
Welcome back to the line to lead. Stay connected to this show at every NOW Media tv. Favorite lidwear on demand anytime you like, Download the free Now Media TV app on Roku or iOS and unlock non stop bilingual programming in both English and Spanish. On the move. Catch the podcast version at www.nowmedia.tv. from business and news to lifestyle, culture, wellness and beyond, now Media TV is streaming around the clock. Ready whenever you are.
Before the break, Dr. Nancy See and I, she basically helped us Understand why cognitive symptoms should not be ignored or minimized. Now we are going to go deeper into how rehabilitation can support new learning, memory, processing speed, and real life functioning.
Dr. Nancy, one thing I love about your research is it focuses on new learning. It focuses on memory and processing speed. Can you explain to the audience why these are so central to independence and quality of life?
[00:12:40] Speaker B: Sure. Let me start with memory. Because memory is very close to my heart in terms of memory functioning. If you think about who you are, how you react in situations, what you like, what you don't like, your relationships, all of that is reliant upon our memory.
When we lose our memories, we lose who we are.
So memory is really central to everything we do. And that's why we really focus in on memory and strengthen strengthening memory and understanding memory. Because memory is really very central to who we are as human beings, as well as our social relationships, our employment, and everything about our lives.
Taking that one step further, memory is one component of a very complicated neural system that we call cognition.
Memory is only one part of cognition. There are many other areas of cognition that are very important.
One of those areas is processing speed.
One of the reasons we focus in on processing speed is because our data and the data of others has shown that when processing speed is impaired, memory functioning is also often impaired.
That's because processing speed, that term essentially refers to the speed with which we can process and understand information.
Information tends to come in very, very quickly, and if you can't keep up with that rapid flow of information, you are not going to be able to remember it.
So processing speed is really core to our other cognitive functions and our ability to function effectively in our everyday lives.
[00:14:35] Speaker A: Thank you so much for that clarity. For the clinicians who are listening, who are in practice, what is an effective cognitive rehabilitation protocol look like?
[00:14:46] Speaker B: They look very different depending on what it is you're treating.
So they're all multi session. That's one thing that's important to remember.
They often will entail upwards of 10 sessions where you're working for at least one hour on a specific skill.
Most of them have homework. The research has shown that when there's homework that does reinforce what people are learning and it does result in greater efficacy of the treatment. So that's actually really important. Homework will follow us for our entire lives.
And the other thing, the other thing people need to think about or clinicians need to think about is the protocols look very different depending on what cognitive function you're actually treating.
So an attention or processing speed protocol will do more Drill and practice. So that means we're doing the same tasks over and over again at a quicker speed and we're pushing the brain to do things faster and more efficiently.
Whereas an effective memory treatment is not like that. An effective memory treatment will have more interaction with a clinician, more skill based training.
So you may take a memory task and teach someone how to do it differently and more effectively in a way that may engage different brain regions to help them learn and remember that information.
So that's another important thing for clinicians to keep in mind.
[00:16:25] Speaker A: No, I love the differentiation and thank you so much for that clarity and explaining it so well.
When we talk about measuring progress and we're looking beyond just basically a test score, really looking at these people and connecting improvement to everyday activities, how are we able to measure that?
[00:16:43] Speaker B: So that's a great question, and it's something that we continue to struggle with.
When someone does a cognitive rehabilitation protocol, we test them for research purposes before they do it and then after they do it. The tests that we traditionally use, our gold standard are neuropsychological tests of memory, attention, processing speed. So they're tests that people are doing paper and pencil tests in a nice quiet environment. So for a memory task, for example, test they may be asked to remember a list of 16 words. We repeat that list five times and we know what someone who's healthy at a particular age can do. And we compare that to that standard. That's not everyday life. You don't typically get a chance to repeat information in everyday life. Very often it's one shot learning. You hear it once and you have to remember it. So everyday life is very different.
To capture everyday life, we ask people, we give them questionnaires, we ask them about their daily life functioning, we ask their significant others how their memory is in daily life, which is very valuable information.
And then the third thing we do is we have tests of everyday life functioning.
So we have tests that will ask someone, read them a medication, medication instructions, and ask them, okay, what did I just tell you? Because that's an important part of everyday life. You sit with your doctor, he goes through those instructions. He or she goes through those instructions pretty quickly. You have to remember that. Or we may ask them to read a newspaper article and then discuss that newspaper article, because that's another very important aspect of everyday life. We may ask them to look at a series of faces and attach them to names and information. So, so those are everyday life tasks that are very different from the gold standard neuropsychological tests. That we use and that's how we kind of capture everyday life for an individual.
[00:18:45] Speaker A: I think what I love most about that is, you know, people who are in our lives, like our family members, they can be aware of what's normal for us. You know, they know what Dr. Nancy is normally like and what she's kind of struggling with versus, you know, if we can catch it early, we do, we know what's wrong or what's not. And we sometimes are not afraid to throw someone else under the bus really quick in the family. Absolutely.
We really do mean to help them.
But it can sometimes feel like that.
[00:19:16] Speaker B: Always good intentions. Always good intentions.
[00:19:19] Speaker A: Oh, absolutely.
Can you explain what role consistency, repetition, patient engagement play in building brain pathways? Building basically new brain pathways.
[00:19:31] Speaker B: So consistency is really important. And this consistency is the key to learning almost anything and initiating any new habit. You need to do it consistently in order for it to have an effect.
The same is true for cognition. As I mentioned earlier, many or all of our cognitive rehabilitation protocols are multi session. And that is because you learn something and then you have to reinforce what you learned at a later date and then reinforce it again and then start building on that.
So when you learn something multiple times over multiple settings, you're not only reinforcing that information, but you're learning it again and attaching it to different environmental cues.
So when we learn something, we have, we learn it within a context.
So you may, this happens a lot. You may say, I know, I know this. I remember I was sitting in my office and it was the middle of the day and I heard it on the radio. But you can't remember what it is, but you remember that context. So that context serves as a cue. Very often if you think about that context, you will eventually get to the information you're trying to remember.
When we learn things repeatedly in different environments, we're providing more contextual cues so we have more cues that help us remember that information at a later time. So that's one of the big reasons that repetition is very, very important.
[00:21:10] Speaker A: No, that's great.
What should patients and family members understand about. I'm going to say realistic expectations during cognitive rehab?
[00:21:21] Speaker B: That's a great question.
Memory does not improve overnight, and that's really important for people to understand.
Your loved one is not going to come in and meet with a clinician in one session and go home better. That's just not the way it works. It takes repeated practice, repeated sessions. And what we hope is that from session one to session ten, we see a change and that's what our research is showing, that from session one to session ten, which happens over a period of five weeks, we do see improved memory, but from session one to session two, we're not seeing improved memory yet. And it would be very unrealistic to expect that. Patience is really very, very important.
[00:22:08] Speaker A: So, so easy to say and really hard to do sometimes.
[00:22:12] Speaker B: And I completely understand it's so frustrating at home when someone is having memory issues when they can't remember. It's very, very frustrating.
But patience really is key to your mental health, their mental health, as well as the efficacy of any program that you're actually trying to engage in.
[00:22:31] Speaker A: Again, Dr. Nancy, thank you for that. After the break, we are going to connect cognitive rehabilitation to the body movement, energy and the emotional experience of healing.
We'll be right back with more practical tools to help you feel healthier, stronger and more aligned. Stay tuned.
And we're back. I'm Dr. Megan Parks and this is Align to Lead on NOW Media Television.
Welcome back to align to lead. We've been talking with Dr. Nancy about cognitive rehabilitation and how the brain and how the brain can be supported through structure, evidence based approaches. And so now we're going to begin by connecting that work to the body to, to daily routines, confidence and emotional resilience.
Dr. Nancy, how do brain injuries, multiple sclerosis or other neurological illnesses affect not only cognition, but also energy, mobility and mood and even self confidence?
[00:23:36] Speaker B: So all of the conditions that you mentioned result in brain pathology, very different types of brain pathology, very different time course in terms of their development as well as what happens once they're diagnosed.
But they all have brain pathology.
When you deal with any brain pathology, there are multiple aspects of functioning that are impacted. So in all of those cases, you have physical deficits that individuals deal with, you have cognitive deficits that individuals deal with, and then you have emotional and behavioral deficits.
What any one individual looks like varies significantly depending on for multiple sclerosis, for example, where their brain lesions are in tbi, it would depend on where that injury is, how extensive that injury is, how old they were when they sustained the injury. So there are so many variables. When someone has a neurological illness or an injury, the symptoms that they portray are very, very individualized. And that's really important to think about.
However, they will encompass all these different areas of function because the brain does all of these different things. It's responsible for so many different things. And there's an impact across the entire spectrum of an individual.
[00:25:01] Speaker A: You kind of are answering my next thought and question But I'm going to go a little bit further into it.
Why is it important when we talk rehabilitation? I can't speak rehabilitation to consider the whole person instead of just cognitive symptoms and isolation.
[00:25:18] Speaker B: And that's a great question. You're right. I did start to go there.
It's important because the brain is responsible for everything.
So if someone's emotional health is less than optimal, that's going to impact their ability to engage in exercise or cognitive rehabilitation or therapy in a rehabilitation facility. That emotional health is very, very important. And it's something that is. In a rehabilitation facility, clinicians will work on to try to get people in a better place so that they can engage. That engagement in therapy is very, very important.
Now, if someone's at home and they're healthy and they're just. They're trying to develop a better lifestyle, it's the same pattern. If someone is depressed, they're less likely to exercise.
However, if someone starts to exercise very often, that depression may start to alleviate.
So while one symptom may impact the ability to engage in that behavior, engaging in that behavior is likely to improve that symptom. So it really is a cycle, and we just have to decide the best place to start to intervene in that cycle, to change it now.
[00:26:35] Speaker A: Good points. Absolutely good points.
One of the other things I love about you, Dr. Nancy, is your trials. They not only just examine through neuropsychological tests, but you also do daily life questionnaires. You do functional neuroimaging. Can you explain to those listening why it's so important and why that matters to study this area through multiple vantage points rather than just one isolated view?
[00:27:02] Speaker B: So when I, as a neuropsychologist, when I do a cognitive rehabilitation protocol, I want to know how cognition changes. So I do a neuropsychological assessment and I see the changes. The person sitting in front of me being treated couldn't care less about my tests. They mean nothing to them. They care about their everyday life.
Insurance companies care about their everyday life.
Physicians care about their everyday life. It's really important that we begin to capture that and that we measure what our treatments, how our treatments impact an individual's everyday life. So that's why we focus so much on everyday life in terms of neuroimaging.
The main reason we do neuroimaging is because we want to understand what is happening at the level of the brain to drive the changes that we're seeing on our testing and in everyday life.
We want to understand at that level largely because if we can Change something and see where it's impacting the brain. We have increased power to develop more techniques that will impact the brain in that manner. So tying everything together is very, very important.
And that's what we're trying to do through the work that we have ongoing at Kessler foundation now.
[00:28:30] Speaker A: That's great.
What have you learned, like watching these patients, what have you learned, like, the experiences of changing with everyday life once they've completed this cognitive rehabilitation?
[00:28:41] Speaker B: The best part of what I do is when a patient comes back and says, I feel so much better.
I can remember such and such, whatever they're trying to remember, or I am able to, to really enjoy being with my family because I'm able to follow along better in conversations.
That is the best part, and that's really the motivation behind what we do. We've learned that the techniques that we are using with people are actually starting to change their everyday life. And that's what we really like to
[00:29:18] Speaker A: see now, as a clinician, I feel like everybody who went into health care, we truly want to help people, you know, and when you're able to and when you're able to see these changes and even see it on imaging, which is just fantastic and amazing, and seeing, like, not even what they're dealing with, but actually having a proven way to measure this, I mean, it becomes more of a passion versus a job, right?
[00:29:44] Speaker B: Absolutely. Absolutely love that.
[00:29:47] Speaker A: How can clinicians, caregivers and families, how can they better support the people who are trying to rebuild cognitive confidence?
[00:29:56] Speaker B: So the most important aspect of living with someone who has a cognitive challenge is to not blame them for that weakness. It's not their fault. And I think that's something that is really hard to remember, because when you're in a relationship with someone, any type of relationship, it's very frustrating when they can't remember things or when they miss aspects of a conversation. And it's very easy to blame the person for not paying attention or not caring enough to remember. It's very easy as human beings to do that. We all do that.
But it's really important to remember that it's not their fault. And by doing that, it's really going to make the situation worse, because then they're going to feel bad and they may get depressed, they may get anxious, they may shut down and interact less. And that really makes the problem worse rather than better. So it's really important not to place blame and to try again to be patient and understanding. And that's so much easier said than done. It is such A challenge. But it is very, very important.
[00:31:14] Speaker A: I'm sitting here thinking 100. What she's saying is a hundred percent true.
Do you guys, do you guys give resources to those people, those family members who, who are dealing with this? Because I'm looking at it and I'm hearing it and I'm like, I completely agree. I couldn't agree anymore.
How can they, how can they get over this? Because I almost feel like we need the rehabilitation for the person going through it and also the person who's trying to support them too.
[00:31:43] Speaker B: So one of the things that's out there that a lot of folks don't know about is there are support groups out there for family of individuals with almost any of these illnesses that we're discussing, particularly in the dementia realm. There are a lot of them. They're organized by county, and they do. I would reach out to county offices to see what your county has that they provide.
In addition to that, though, on our website, which is KesslerFoundation.org, we have consumer resources.
So for example, in our, on our TBI webpage, traumatic brain injury webpage, we have brainstorms, which are short lectures, webinars given by people who have had a brain injury from toward. Focused toward an audience that has had a brain injury. So it's someone with a brain injury trying to help someone who may have a newer brain injury. And those are really great topics, really interesting brain, really interesting webinars that people who have a traumatic brain injury can watch to try to help them. We have webinars like that that are focused on caregivers. We have newsletters, consumer newsletters. So we have. And that's an example in traumatic brain injury. But on our website, we have them across different populations. And I would encourage people to go on our website and take a look and see if there are things that they can download that would help them.
I think they'd be very happy with what they found there.
[00:33:18] Speaker A: No, thank you for that and shout out to your company for offering that for people. I've, I've discussed with other people. My grandma had dementia, so I actually understand, and I understand the struggle it was as she was living with my parents, so sometimes it's easier said than done. But thank you so, so much for, for giving that wealth of information for people out there, just even to know that they're not alone. That alone is huge.
[00:33:43] Speaker B: Absolutely perfect.
[00:33:45] Speaker A: Well, when we return, what we're going to talk about is the future of cognitive rehabilitation, what research is revealing and how viewers can advocate for better support and care.
We'll be right back with more practical tools to help you feel healthier, stronger and more aligned. Stay tuned.
And we're back. I'm Dr. Megan Parks and this is Aligned to Lead on Now Media Television.
Welcome back to Align to Lead. Stay connected to this show and every NOW MEDIA TV favorite live or on demand, anytime you like. Download the free Now Media TV app on Roku or iOS and unlock non stop bilingual programming in both English and Spanish. On the move. No problem. Catch the podcast version at www.nowmedia.tv. from business to news to lifestyle, culture, wellness and beyond, NOW Media is streaming around the clock. Ready whenever you are.
Before the break, Dr. Nancy and I were talking about helping. She basically helped us all understand the deep connection between cognition, body function, daily life and emotional resilience.
In this final segment, we are going to be looking forward at research, advocacy and what patients and families can do when they want and deserve better answers.
Dr. Advanci, I am very curious. What excites you the most about the future of cognitive rehabilitation research?
[00:35:17] Speaker B: I think what excites me the most is the potential.
We have demonstrated that there are multiple cognitive rehabilitation protocols that are indeed improving individuals cognitive functioning. And I think now that we have these protocols that are very clearly working, I think adapting them to different populations, identifying new protocols based on what we've learned, and making them accessible remotely, that is all really, really exciting because it's giving people an opportunity to take control of their own brain health. And that's a very, that's very, very important.
[00:35:59] Speaker A: Oh, absolutely. For those patients and families and even clinicians out there, how can research findings be translated into practical support?
[00:36:09] Speaker B: That's a great question. And that is a large part of what we do at Kessler Foundation. We really focus in on translational research.
So where that means we're taking research that might have been done in a laboratory and we're trying to take it into the everyday world so that people can actually access it.
So in order for people to understand what we're doing, I incur always encourage people to educate themselves, to go online, see what's out there, understand what research projects are ongoing and try to engage in that research. Because if you can engage in that research, a couple of things happen.
One, you become more knowledgeable as to where the field is going and what is available and out there. But the other thing that happens is very often you can get involved in a clinical trial and actually get the treatment that we're testing and that could be very, very beneficial to you.
[00:37:12] Speaker A: Oh, absolutely. Good point. I never even thought about that, how, you know, looking into it, you can actually open up opportun.
And thank you for sharing that with the viewers.
I am so big on empowerment. So my next question is going to be what should a patient or caregiver ask when they're seeking help? Or basically understanding that cognitive changes, whether it be after a brain injury, multiple sclerosis, or even any other neurological illness, what are the important questions they should be asking their provider?
[00:37:44] Speaker B: So I think the first, I think the first thing people need to do is they have to go into appointments with the mindset that they're going to ask questions, push the provider. The provider is going to provide you with information, but then ask questions about that information. And if the provider in front of you is not able, doesn't have time to answer those questions, you're generally in an office setting. There are other providers there. There may be nurses, receptionists, but there are typically other clinicians there that can help you. So make sure if you have a question, you ask it. That's the first thing. The second thing is if someone's telling you you have a neurological illness or injury diagnosis and that it often comes with cognitive consequences either now or down the road, ask for a neuropsychological evaluation.
Even if your cognition is perfectly intact, that's a great time to get a baseline neuropsychological evaluation done because that's going to help you later. When decline does happen, then you could get another evaluation and compare it to that baseline. That comparison is really, really useful for your clinical team to know where you started and where you are now, and then perhaps be able to direct treatment in the right areas.
So that's the other thing that is very, very important, is to try to get that evaluation.
[00:39:15] Speaker A: No, that's good. What would happen if they were getting pushback? They're asking their provider, and their provider's like, you're fine. You don't need this. Why?
What would you, what would you suggest to those people?
[00:39:27] Speaker B: I would suggest that they seek other help. And it may be a second opinion within that field. It may be reaching out and finding your own clinician in the area that you're looking for. So if the provider says you're fine, okay, that's fine. I'll take that and I'll go home and I'll go, I'll Google neuropsychologists and I'll find someone myself.
So take, take control. Take the power into your own hands. If the provider is not going to refer you to someone Then go out and find somebody yourself.
[00:40:05] Speaker A: I am 100% with you. I always tell people it has to make sense, you better ask questions. You are never going to offend me and if it does, I'm not the right provider for you.
So no, I love that. How can women become stronger advocates for themselves when their symptoms, just like we just talked, are dismissed or even not fully understood?
[00:40:27] Speaker B: That happens a lot and it particularly happens a lot to women, unfortunately.
So I think the best advocacy is to do exactly what we were just talking about. When someone is dismissing your symptoms, find somebody else who's not going to dismiss your symptoms. And this honestly just happened to me in one of my own appointments where my physician dismissed my symptoms. And I basically said, there's no, I do not believe that you don't have a way to address this. He said, we don't. So I went and found somebody who did have a way to address it. So I think that's really, really important is we have all of this information at our fingertips now with the Internet, with AI, we can go online and find information and try. Now you have to be careful because there are people out there that are not well intentioned. So you do have to do your research as to who you're going to see and what you're going to see them for. But I do think we do have power to find other clinicians that may be in a better position to help.
[00:41:34] Speaker A: Oh, I couldn't agree with you more. What message of hope do you offer someone who may be struggling with cognitive changes and sadly wondering. They're in a very dark place. They wonder if improvement's even possible in their situation.
[00:41:49] Speaker B: I think people have to hang on to the fact that there is a lot of research ongoing and we're making progress every day. I think it's really important for people to not only know that, but remember that.
And then I also think people need to remember that we are in some control ourselves.
We can exercise, we can engage socially, we can cognitively challenge ourselves, we can eat healthy. All of those things are going to lead to better brain health. And that's where people could really take control of their own brain health. No matter what stage they're at in terms of their cognitive health, you can always strengthen it by doing those things.
[00:42:35] Speaker A: No, that is, that is so good. And any research or any, any areas that they can go for more information on that, you know, just the first steps, because I feel like some people just do not know where to start. They're getting overwhelmed, they're getting or they're getting dismissed and they're wondering am I getting being crazy?
And you know, is there anything that you could say, hey, I would start
[00:42:59] Speaker B: here, I start online and I would go to trusted sources. So places. Kesslerfoundation.org is certainly one. We have a lot of information out there to help folks. All of our email addresses are available so they can reach out to us and we will certainly refer to, refer them to places or to resources that we know are available.
But there are other reputable organizations out there and mayo clinic.org or, you know, other organizations like that where we know that these are reputable organizations that do very solid work. Those are the places that I would go and that's where I would start.
[00:43:41] Speaker A: Absolutely. The org versus just the.com and Dr. Google.
It'll tell you a lot of things and some aren't really good.
Well, Dr. Nancy, for viewers who want to learn more about you and how to connect to you and Kessler foundation, what can they do? How can they find you?
[00:44:03] Speaker B: The best place to go is online. I feel like a broken record. I keep referring people online, but KesslerFoundation.org is our website. You can find all of our scientists on there as well as we have a very, very broad range of resources. Rehabilitation, research, everything from physical functioning to emotional functioning to cognitive functioning. And I would encourage people to jump on the website and peruse, take a look. There are a lot of consumer resources on there that people can benefit from.
So definitely jump on and see if they, if we'd be happy to engage with folks.
[00:44:38] Speaker A: No, that's amazing. I do, I love the work you're doing. I love your guys's mission. I love that you're able to support so, so many people.
And I just want to thank you so much for basically bringing importance and clarity to the conversation. You know, and that's, you know, cognitive symptoms can affect confidence and that's so sad. It can affect relationships, it can affect work, independence and sadly, even identity.
But again, they should never be ignored, minimized, or even treated like something someone has to accept. And unfortunately, too often that is the message. But I will say today's conversation reminds us that the brain can be supported and it can be done by recovery and it can be studied and healing must include that whole person. Thank you so much for everything you do and by doing that, and I also want to do and say thank you for everyone watching. Please, please, please pay attention to what your body and brain are trying to tell you. If memory focus or processing speed fatigue or even daily function has been changed.
Seek support, ask better questions, and keep advocating for care that looks beneath the surface. I'm Dr. Megan Parks, and this is Aligned, a Lead.
